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SAN JOAQUIN COUNTY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • r.., �p Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.s'oov.org/ehd <br /> 9GI FUM1� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CA Date: b—z9— <br /> ddress: 33 r City: ;r.% _ Zip Code: <br /> Owner/Operator: 1... Telephone: <br /> Program Element: ` Z Program Record: \�Q Z ) Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 2 1 S <br /> "T <br /> \ 1 <br /> C <br /> 3 <br /> er <br /> - IbZ <br /> - F= - 12 <br /> ) - *sere-) <br /> _ <br /> . .. , ,ltemA ocation ,;;,;; Temperature Item I Location Temperature; <br /> Food Safety Certification ]Hand <br /> cility Hot Water Temperature Warewashing <br /> Namey ink: `F Chlorine: Ppm Heat: "F <br /> Exp.Date: arewashing Sink: of IQ <br /> uat.Amm.: PPM Other: "F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: 2 Time Out: Page 1of <br /> EHD 16-24 (2^ pg) 4P 13 FOOD PROGRAM OR CONTINUATION <br />